Major Protective Factor Research Articles

What should a nation do to prevent common mental disorders? Meet seven conditions for effective prevention

The global burden of Common Mental Disorders (CMDs), including depressive, anxiety and substance use disorders, is substantial. Since increased treatment has not reduced CMD prevalence, prevention is a logical approach to reduce CMD burden. However, CMD prevention as currently delivered has not reduced prevalence. Seven conditions need to be met to maximize the long-term effectiveness of CMD prevention: 1. Target young persons early in life and families. 2. Modify major CMD risk and protective factors. 3. Embed in social institutions and culture. 4. Implement via synergistic programs of proven effectiveness in multiple community settings (pre-school and kindergarten, elementary and secondary schools, child and health care, social welfare/family support). 5. Secure long-term funding with permanent, structural integration into community organizations. 6. Address socio-economic disadvantage and attendant risk factors. 7. Use the power of policy. We consider how these conditions might be achieved in large populations. A dilemma is that compelling evidence regarding the benefits of CMD prevention may be needed to motivate large, long-term investments, but until society has made and sustained these investments for 10 to 20 years, full benefits of CMD prevention may not be realized. Therefore, we propose regional implementation and evaluation focused initially on proximal benefits for child development. Developmental determinants important to educators, parents and other stakeholders should be evaluated initially to establish short-term pay-offs for educational and behavioral outcomes. Long-term CMD prevention initiatives may not only prevent CMDs, but also develop resourceful, resilient, and well-educated children and adults.

Economic disadvantage and depressive symptoms among Arab and Jewish women in Israel: the role of social support and formal services

ABSTRACT Objectives Depression is a major public health concern due to its high prevalence and association with functioning. Ethnic minorities in Western countries are more likely to experience economic disadvantage and exposure to stressors that may put them at higher risk of developing depression. One major protective factor associated with reduced depressive symptoms is an existing support network. This study examined the associations between economic disadvantage, formal and informal social support, and depressive symptoms among two ethnicity groups in Israel: Arab and Jewish mothers of young children, as well as the potential mediating role of formal and informal social support in the associations between economic disadvantage and depressive symptoms. Design We recruited a representative sample of 837 Jewish and Arab mothers of children aged 2–6 years. We collected data via structured face-to-face interviews following approval of the university ethic committee. We used the Center for Epidemiologic Studies Depression Scale (CES-D), the Medical Outcomes Study (MOS) scale to measure maternal perceived social support, and a measure designed for this study to quantify formal social support. Results Compared to the Jewish mothers, Arab mothers reported more depressive symptoms, greater economic disadvantage, and fewer informal and formal support networks. Economic disadvantage was negatively associated with informal support but positively associated with formal support among both Jewish and Arab mothers. Results further revealed that informal and formal social support mediated the associations between economic disadvantage and symptoms of depression. Conclusions More attention should be paid to the associations between social determinants and mothers’ mental health, with a possible shift of focus to macro-level factors, such as economic inequality and minority status.

Dementia, stroke, age, use of medical devices and antipsychotic drugs may increase the risk of nosocomial infections among elderly patients hospitalized at Neurology Clinics

Healthcare-acquired infections (HCAI) represent a major health problem worldwide. Stroke and dementia are considered risk factors for HCAI. Preliminary data suggest that use of antipsychotic drugs also increase the risk for HCAI. Here, we performed a retrospective study aimed at investigating the major risk and protective factors for HCAI in a cohort of elderly subjects hospitalized at an Italian tertiary Neurology Clinics. We included all patients with age ≥ 65 years hospitalized at Neurology Clinics of National Institute on Ageing, Ancona, Italy from 1st January 2018 to 31st December 2021. For each patient, the following data were collected: age, sex, use of medical devices, comorbidities, use of antipsychotic medications, development of HCAI. We included 1543 patients (41.4% males; median age 85 years [80–89]). According to multivariable analysis, age, stroke, duration of urinary catheter placement (for all p < 0.001) and midline placement (p = 0.035) resulted to be risk factors for HCAI, Diabetes resulted to be a protective factor for pneumonia (p = 0.041), while dementia and nasogastric tube were risks factor for this condition (p = 0.022 and p < 0.001, respectively). Urinary catheter was a risk factor for urinary tract infections (p < 0.001). Duration of placement of vascular catheters and use of antipsychotic drugs resulted to significantly increase the risk for bloodstream infections. Stroke, age and use of medical devices were confirmed to be risk factors for HCAI. Antipsychotic drugs resulted to increase risk for bloodstream infections. Further prospective studies will be needed to confirm these findings.

Indoor environment in relation to recurrent childhood asthma in Yancheng, China: a hospital-based case-control study.

This investigation explored the association between indoor environmental factors and childhood asthma in Yancheng, China. Asthma case (201 children with recurrent asthma) and control cohorts (242 healthy subjects) were recruited from a Traditional Chinese Medical (TCM) Hospital in Yancheng city, based on the results of an ISAAC questionnaire. Questionnaires regarding environmental risk factors were completed by the child's primary caregivers. To compare data on environmental VOCs and formaldehyde contents between asthma and control cohorts, we passively conducted a 10-day indoor and outdoor sampling. Breastfeeding was a major protective indoor environmental factor for recurrent asthma (adjusted odds ratio [aOR]: 0.368, 95% confidence interval [CI]: 0.216-0.627). Our analysis revealed that childhood recurrent asthma was intricately linked to a family history of asthma. Recurrent asthma was also associated with passive smoking [aOR2.115 (95%-CI 1.275-3.508)]. Analogous correlations were observed between household renovation or new furniture introduction and recurrent asthma [aOR3.129(95%-CI1.542-6.347)]. Benzene and formaldehyde were present in all examined homes. Enhanced benzene and formaldehyde concentrations were strongly evident among asthma versus control cohorts, and they were strongly correlated with augmented recurrent asthma risk. Home environment heavily regulates incidences of childhood recurrent asthma. Hence, actions against the indoor environmental risk factors described in this study may assist in the prevention of recurrent asthma among children.

Enhancement of Antioxidant Properties of the Medicinal Plant, Costus Pictus by Optimization of its Drying and Extraction Criteria.

Antioxidants act as major protective factors against different infections and diseases. The search for natural antioxidants has gained significant momentum due to its associated health benefits. It prompted the investigation of the antioxidant properties of widely recognized medicinal plants, considering their prominent role in conventional medicine. The incorporation of natural antioxidants derived from medicinal plants into food products has the potential to enhance their health benefits. The present investigation is the first study on the optimization of drying and extraction techniques in Costus pictus leaves. C. pictus leaves were dried under varying conditions (40, 50 and 60°C) and dried powders were subjected to various solvents, namely water, ethanol, methanol and ethyl acetate. The leaves dried at 60°C and treated with ethanol showed improved activities and were subsequently selected for further extraction. Among the various extraction methods, ultrasound-assisted extraction demonstrated superior antioxidant properties and increased phytochemical contents, making it the optimal technique for our study. Fourier transform infrared spectroscopy (FTIR) reports also substantiated these quantitative results. The extraction process played a significant role in enhancing the desirable attributes and properties of the leaf extracts, surpassing the results obtained from both dried and fresh leaves. The application of liquid chromatography-mass spectrometry (LC-MS) analysis to the leaf extracts facilitated the identification of phenolic compounds and flavonoids, presenting a comprehensive insight into the composition of the extract. Exploration of antioxidant properties, phenolic compounds and flavonoids would validate the benefits and expand the applications of C. pictus in functional foods and nutraceuticals.

The role of parents’ and friends’ support in preventing suicide attempts among French sexual minority adolescents

ObjectivesFrench sexual minority adolescents are at higher risk for suicide attempts than their heterosexual peers. However, little is known about the role of parents’ and friends’ support among French lesbian, gay and bisexual (LGB) youth. This study aimed to research the role of their support in preventing suicide attempts among LGB adolescents in France. Materials and MethodsData were drawn from a French cross-sectional study entitled “Portraits d'adolescents”. Parental support was defined by satisfactory relations between participants and their parents. Friends’ support was defined by satisfactory relations between participants and their friends. Chi-square and multiple logistic regression analyses were used to estimate and identify associated factors of suicide attempts in LGB as opposed to heterosexual youth. ResultsData from a sample of 14,265 French adolescents aged 13 to 20 were analyzed. Among them, 637 (4.47%) identified as LGB. Attempted suicide was independently associated with sexual orientation (30.7% vs 10.6%; OR = 2.59 [2.11–3.18]; p < 0.0001). Both parents’ and friends’ support appeared to be protective factors in suicide attempts among heterosexuals (adjusted ORs = 0.40 [0.35–0.46] and 0.61 [0.51–0.75], respectively), whereas in the LGB group, only parental support was significant (adjusted OR = 0.42 [0.27–0.65]), independently of other variables. DiscussionPrevention efforts might be carried out by identifying within-group differences among French adolescents with different sexual orientations. The supportive role of family members should be strengthened. Positive resources and salutary support systems may effectively prevent suicide attempts. ConclusionsFrench LGB adolescents have a higher risk for suicide attempts than their heterosexual peers. Parental support was reconfirmed as a major protective factor against suicide attempts in sexual minority adolescents.

Le rôle de l’alexithymie dans les comportements violents : Une révision des études disponibles à la lumière du modèle de traitement de l’information sociale

ObjectivesThe literature highlights the prevalence of shortcomings in processing emotional information, especially the identification of emotions in the context of violent behavior. Alexithymia is the inability to recognize and describe emotional states and external oriented thinking. The social information processing approach offers a theoretical framework to understand how alexithymia deficiencies are linked to violence. Furthermore, this approach allows us to determine which stages of processing are associated with specific kinds of deficiencies in order to adapt treatment programs targeting violent behavior. The primary goal of this narrative review is to define and present the relationship between alexithymia and violent behavior. In addition, this review will attempt to illustrate that deficiencies caused by alexithymia are related to different stages of social information processing. MethodsThis review presents an explanation of the links between violent behavior and alexithymia according to the social information processing theory as a theoretical framework. ResultsThere are numerous studies that demonstrate the relationship between violent behavior and alexithymia in different populations (general, psychiatric, or incarcerated) and for different kinds of violence (physical, homicidal or sexual). In particular, the deficiencies caused by alexithymia primarily involved the (in)ability to identify emotional states. Indeed, the more people have difficulties in identifying their own internal emotional states, the higher the probability that they will engage in dysfunctional behavior such as violence. According to the social information processing model, these shortcomings are present in the initial stages of processing. Errors in detection and perception of social cues could produce a misinterpretation of other's intentions and could lead to a hostile attribution bias. This bias exhibits itself as a tendency to interpret the actions of others as hostile, particularly in ambiguous situations and is often linked to impulsive and reactive aggression. Due to these links between alexithymia, misinterpretation, and violent behavior, it seems essential to develop treatment programs designed to reduce the effects of alexithymia. One study demonstrated that a specific treatment program reduced alexithymic related deficiencies among individuals who had committed sexual offences. This program was based on developing the capacity to identify emotions and to use emotive language to verbalize emotional states. These results suggest that it is possible to improve emotional competence and reduce the effects of alexithymia, which could lead to a reduction in errors in social information processing and could be a major protective factor with respect to violent behavior. ConclusionsThe social information processing model allows us to understand the relationship between violent behavior and alexithymia based on the deficiencies in specific processing stages. In other words, this is an approach which examines the varying stages of social information processing which are dysfunctional and their relationship to the various dimensions of alexithymia. Importantly, it seems that the two explanatory hypotheses of alexithymia may be more complementary rather than diametrically opposed. Indeed, these two hypotheses allow us to explain particular kinds of deficiencies based on different stages of social information processing. This heuristic framework promises the possibility of understanding the study of alexithymia depending on both the nature of the shortcomings and on which social information processing steps are involved. Accordingly, it could become easier to accurately understand which processes are involved in order to adapt the treatment of these deficiencies, particularly in relation to violent behavior.

High number of refugees in Italy - which strategy works in Italy?

AbstractA negative impact on mental health of Ukrainian people who will survive the war is very likely.Those who leave are exposed to the trauma of leaving behind home, relatives, friends, job, habits, i.e., most of what they had built in their life, and to the unpleasant feeling of knowing nothing of what they will go through.Mutual support and nurture problem-solving strategies, including favoring family reunion, restoring people dignity and control over the environment, help children recover a more positive social reality, are major protective factors in buffering the impact of war, displacement and related trauma.By November 2022, Italy had hosted more than 170.000 Ukrainian refugees. The National Service intervention, coordinated by the Civil Protection Department, has developed a Plan for the reception and assistance of the population from Ukraine to uniform the response to the emergency on the national territory. The plan has focused on two aspects: humanitarian assistance and reception. The network for reception is composed of the CAS - Extraordinary Reception Centers and the SAI - Integration Reception System. The Plan also provides measures related to health care and education to ensure mandatory vaccination requirements and the access to the school system for unaccompanied foreign minors. As to plans aimed to address mental health issues, the right to care is guaranteed, but several issues can be identified that limit the impact of the national policies on the needs of this population.Disclosure of InterestNone Declared

Cultivating resilience among Hong Kong's underprivileged ethnic minority groups in the face of a pandemic through a social justice lens

PurposeIn this study, the authors investigated ways to cultivate resilience through a social justice lens among ethnic minorities against COVID-19 in Hong Kong.Design/methodology/approachA qualitative (case study) methodology was adopted to interview 15 social service providers from diverse ethnic backgrounds serving disadvantaged ethnic minority groups (South and Southeast Asian groups from low-income households, foreign domestic workers and asylum seekers/refugees).FindingsTwo major protective factors were identified, contributing to the development of resilience among diverse ethnic groups: (1) individual-based resilience (including being optimistic) and (2) socio-environmental factors (including ongoing support from strong family, peer and religious settings' support, consulates' support, on-going material and nonmaterial donations, support of young volunteers and importance of online connection and communication) using the integration of resilience and social justice frameworks.Originality/valueThis study showed that the protective factors were found to dynamically interact with each other and the environment. The present study recommends additional culturally sensitive service and policy implications for preventing the long-term impact of mass crises among Hong Kong's marginalized minorities.

The Effects of the First Phase of the Covid-19 Pandemic on the Mental Health of Children and Adolescents With preexisting Psychiatric Conditions.

Few studies have examined the impact of the initial school closures and stay-at-home orders on those vulnerable children and adolescents with preexisting psychiatric conditions. In our study, we explore the impact on this population and identify risk and resilience factors by looking both at those children who were impacted negatively as well as those who were impacted positively by this period. Questionnaires were administered by child and adolescent psychiatrists to 101 parents of child and adolescent outpatients in a mental health clinic as well as 75 of the adolescents, themselves, during the initial stay-at-home orders in Israel. Parents and their children were asked how the situation changed the symptoms for which the children are being treated at our clinic. Information regarding demographic, family, and individual factors was also gathered. The largest group of parents (44%) reported improvement in their child's symptoms during this period, whereas 33% reported no change and 25% reported worsening. Risk factors included parental stress and level of child preoccupation with Covid-19. The major protective factor was parental presence. Although home confinement during the Covid-19 pandemic can lead to worsening mental health status among children, it can also provide an opportunity for those with previous mental health conditions to improve and strive. For these children to improve during such a period, decreased social and academic demands and increased parental presence seem to be key factors. For those who deteriorate, identifying and targeting parental stress can be as important as targeting the child's stress during such times.

A Systematic Review of the Risk and Protective Factors of Tobacco Use among South Indian Adults

Background: India is facing a crucial health burden due to the incremental rise in the prevalence of tobacco use and associated diseases. Sociocultural factors largely influence tobacco use behaviour. Hence, documenting the risk and protective factors associated with tobacco use among the South Indian population helps develop context-based interventions and policies to reduce tobacco-related issues. Objective: This systematic review aims to synthesise the available literature evidence on the risk factors contributing to tobacco use and the protective factors safeguarding against this health risk behaviour among South Indian adults. Methods: The primary author conducted a PRISMA-compliant systematic search using five databases: PubMed, Scopus, Web of Science, Wiley Online Library, and Science Direct from the inception to June 23, 2021. A manual search was also done in Google Scholar to find pertinent publications. 13 articles that met the review's inclusion criteria were selected from the 5063 articles that were initially found after a thorough screening process and suitable quality assessment. According to the socio-ecological model, the risk and protective factors identified were divided into five levels: intrapersonal, interpersonal, organisational, community, and public. Results: From the included studies, the major risk factors found were stress, low perceived health effect, low income, peer influence, nature of the occupation, lack of awareness about health effects due to community marginalization, community misconception of positive aspects of tobacco use and ease of availability in the market. The major protective factors identified were awareness, perceived harm to social image, familial support, community-based health education, exposure to tobacco warning labels and government initiatives of tobacco control. Conclusion: The multi-level factors identified from the current review findings reveal the need for population and context-specific interventions as well as the tobacco control policies to be developed in the near future. Interventions tailored to address the risk factors and incorporate the protective factors identified would benefit the South Indian community in tackling this health burden.

Should I Help? Prosocial Behaviour during the COVID-19 Pandemic.

The Movement Control Order (MCO) enacted during the COVID-19 pandemic has profoundly altered the social life and behaviour of the Malaysian population. Because the society is facing huge social and economic challenges that need individuals to work together to solve, prosocial behaviour is regarded as one of the most important social determinants. Because it is related with individual and societal benefits, participating in prosocial activities may be a major protective factor during times of global crisis. Rather than focusing only on medical and psychiatric paradigms, perhaps all that is necessary to overcome the COVID-19 risks is for individuals to make personal sacrifices for the sake of others. In reality, a large number of initiatives proven to be beneficial in decreasing viral transmission include a trade-off between individual and collective interests. Given its crucial importance, the purpose of this concept paper is to provide some insight into prosocial behaviour during the COVID-19 period. Understanding prosocial behaviour during the COVID-19 pandemic is crucial because it may assist in the establishment of a post-COVID society and provide useful strategies for coping with future crises.

Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors.

Background: The COVID-19 pandemic has strained hospitals and healthcare workers engaged in combating the virus with limited knowledge and resources. Intensive care unit (ICU) nurses are among the healthcare workers most affected by the pandemic and are at risk for developing burnout syndrome. Objective: The present study aims to explore burnout symptoms prevalence among ICU nurses and to identify the individual, organizational, and contextual risk, and protective factors of burnout in ICU nurses during the COVID-19 pandemic. Methods: A scoping review was conducted by searching PubMed, Scopus, and Web of Science. Only papers with empirical data and referred to ICU nurses were included. A total of 350 initial results were yielded, and 40 full texts were screened. Twelve papers constituted the final sample in the analysis. Results: High levels of symptoms of burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) were registered among ICU nurses during the COVID-19 pandemic. Increased workload, lack of equipment, social stigma, and fear of contagion emerged as key risk factors. Social support from leaders and colleagues, professional recognition, use of personal protective tools, and witnessing patients’ successful recovery emerged as major protective factors. Conclusions: The results may inform the development of timely actions to counter burnout in ICU nurses during this COVID-19 pandemic and in a post-COVID-19 scenario.

We are preventing some dementias now-But how? The Potamkin lecture.

Most dementias are untreatable and their prevalence is increasing around the world. However, the incidence of dementia is declining in some countries. We need to find out urgently why and how and apply the lessons promptly and widely. Given the multiplicity and variability of environmental, socioeconomic, and individual risk and protective factors, the approach needs to be comprehensive, customized to work in a particular setting, and cost effective, to justify the needed funding. Stroke, heart disease, and dementia share the same major preventable risk and protective factors and pose risks for each other. Preventing them together might result in efficiencies and economies of scale. Prevention can best occur in existing actionable population health units through established leaders in government, non-governmental organizations, and the community, around a positive message of promoting brain health as the key to health, productivity, and well-being.

Development and validation of the parents’ cognitive perception inventory of disaster effects on children’s well-being (PCP-DCWB)

BackgroundParents’ cognition about the type and nature of consequences a disaster may pose on the children’s psychosocial health, could be a major protective factor against the long-term overwhelming complications. Given the lack of a reliable instrument to measure parents’ cognition about disasters’ effects on children’s well-being, this study was conducted to develop and validate the parents’ cognitive perception inventory of disaster effects on children’s well-being (PCP-DCWB).MethodsIn this cross-sectional study 300 parents of the survived primary school aged children from the Iran’s northwest earthquake on August 2012 were recruited in the city of Varzegan. Exploratory factor analysis (EFA) was applied to identify the subcomponents and Cronbach’s alpha and Guttmann Split-half coefficients were calculated to assess the internal consistency reliability of the scale.ResultsStructural indicators of the Kaiser–Meyer–Olkin measure (0.69) and Bartlett’s test of Sphericity (P < 0.001, df = 153, X2 = 618.35) verified interpretability of the EFA output. Applying principal component analysis and direct oblimin rotation in the EFA four latent factors were identified (i.e., perception about child overall mental health, coping with trauma’s long-term effects, children or parents’ continuing memory of past disaster and perception about behavioral and educational problems) which explained 49.32% of the total variance. The estimated Cronbach’s alpha and split-half reliability coefficients (0.71 and 0.52 respectively) supported good internal consistency of the instrument.ConclusionThe study findings revealed sound psychometric attributes of the PCP-DCWB to be applied in assessment of parents’ cognition about psychological impacts of a traumatic event on the survived children. The instrument application can shed light on level of pre-disaster preparations in local, national and international scales and help effectiveness assessment of interventions that target maintenance of psycho-social well-being among disaster-affected survivors over time.

Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support

ABSTRACT Background: The COVID-19 pandemic is an unprecedented stressor for frontline healthcare workers, notably increasing acute stress disorder and depression rates. Emotion regulation and social support could be major protective factors against such psychopathological states, but their role has not been explored outside Western contexts. Objective: To assess the association between emotion regulation, social support, acute stress disorder, and depression among healthcare workers directly confronted with the first wave of COVID-19 pandemic in the eastern Democratic Republic of the Congo. Method: A cross-sectional study assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) emotion regulation strategies, social support (instrumental, emotional, and informational levels), as well as self-reported situations and feelings related to COVID-19, in a population of 252 frontline healthcare workers (121 women; 131 men; mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We also explored the relations between these variables through bivariate and multivariate logistic regression. Results: Forty percent of participants presented symptoms of depression, and 16% presented acute stress disorder. In bivariate logistic regression, these psychiatric outcomes were associated with the availability of a COVID-19 protection kit [OR = 0.24 (0.12–0.98)], hostility toward health workers [OR = 3.21 (1.23–4.21)], putting into perspective [OR = 0.91 (0.43–0.98)], self-blame [OR = 1.44 (1.11–2.39)], catastrophizing [OR = 1.85 (1.01–4.28)], blaming others [OR = 1.77 (1.04–3.32)], emotional support [OR = 0.83 (0.49–0.98)], instrumental support [OR = 0.74 (0.28–0.94)], and informational support [OR = 0.73 (0.43–0.98)]. In multivariate logistic regression, hostility [OR = 2.21 (1.54–3.78)], self-blame [OR = 1.57 (1.02-2.11)], rumination [OR = 1.49 (1.11-3.13)] and emotional support [OR = 0.94 (0.65-0.98)] remained significantly associated with psychiatric outcomes. Conclusion: Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic. Hostility, self-blame, rumination, and social support were associated with depression and/or acute stress disorder and should be targeted by interventions aiming to support health workers’ wellbeing. HIGHLIGHTS Frontline health workers presented high prevalence of acute stress disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic in the Eastern Democratic Republic of the Congo, as they were working in hostile environment without enough protection kits. Acute stress disorder and depression were negatively associated with adaptive emotion regulation and social support; and positively with maladaptive emotion regulation. Intervention aiming to support health workers in pandemics should target emotion regulation and social support.

Supporter-focused early intervention for recent sexual assault survivors: Study protocol for a pilot randomized clinical trial

IntroductionSexual assault is a common form of trauma that is associated with elevated risk for negative psychosocial outcomes. Although survivors' social relationships could serve as a major protective factor against negative outcomes, survivors' supporters often lack knowledge regarding effective responses and may inadvertently respond in ways that are detrimental to healing. Communication and Recovery Enhancement (CARE) is a 2-session early intervention for survivors of a past-10-week sexual assault and their supporters that aims to improve supporters' ability to respond effectively. ObjectiveIn this paper, we present a study protocol for a pilot randomized clinical trial of CARE (NCT05345405). The goal of this pilot trial is to understand the feasibility, acceptability, and preliminary efficacy of two versions of CARE: a version in which survivors and supporters attend sessions together (dyadic version) and a version in which supporters attend sessions alone (supporter-only version). MethodsSurvivors aged 14+ with elevated posttraumatic stress will enroll with a supporter of their choosing. Dyads will be randomized to dyadic CARE, supporter-only CARE, or waitlist control, and will complete self-report assessments at baseline, post-session-1, and follow-ups (1, 2, and 3 months post-baseline). We will use descriptive statistics, effect sizes, and exploratory statistical tests to characterize the acceptability of both CARE versions, impact on knowledge change from baseline to 1 month, impact on disclosure experiences at 1 month, and impact on functional outcomes at 3 months. DiscussionResults will be used to inform future changes to CARE and determine whether a fully-powered randomized controlled trial is warranted.

Actin‐Fence Enhancement Protects against Extra‐Pulmonary Infection of Pseudomonas Aeruginosa

Lung‐endothelial membrane damage underlies acute lung injury (ALI), a major cause of mortality. ALI occurs after extra‐pulmonary infection by Gram‐negative bacteria. However, damage‐inducing bacteria‐endothelial interactions are unclear. Endothelial uptake of blood‐borne bacteria might induce cell‐membrane pores (CMPs), leading to membrane damage. Since the cytoskeletal involvement in this membrane damage remains unclear, we explored the role played by the membrane stabilizing, cell cortical f‐actin layer (PMID: 33749665). We induced extra‐pulmonary infection in mice, by intraperitoneal (i.p.) inoculation of fluorescent (GFP‐labelled) Pseudomonas aeruginosa (GFP‐PA) (3.5x106 cfu). In one group (n=5), after 40 hours we carried out real‐time confocal microscopy (RCM) of the lung to determine GFP‐PA interactions with calcein‐red (CR)‐loaded lung endothelium, per our reported approaches (PMID: 33749665). In another group, we carried out single‐blind assessments of survival in mice given no therapy (n=10), or the actin fence enhancer, TAT‐V12Rac1 (PMID: 33749665) by intravenous injection 7 hours after PA inoculation (n=10). RCM of live lung microvessels revealed GFP‐PA as green particles attached to the lung‐endothelial surface. Therefore, bacteria released from the peritoneum, reached the lung by the blood route. Confocal sections taken through the cell interior revealed internalized bacteria as yellow particles, reflecting the merged fluorescence of green (bacteria) and red (cytosol). Imaging indicated slow loss of CR fluorescence over the time course of an hour. As we reported, this slow loss of cytosolic dye indicates CMP formation (PMID: 22561462). In the survival assay, 80% of the mice died within 3 days of PA inoculation (p&lt;0.01 versus PBS control). By contrast, in the group given TAT‐V12Rac1, mortality was markedly less at 30% (p&lt;0.01 versus bacteria alone). We show for the first time, that within 2 days of i.p. inoculation, GFP‐PA internalized in lung endothelium, causing CMP formation. A day later there was high mortality that however, could be majorly abrogated by enhancing the endothelial actin fence by therapy with intravenous TAT‐V12Rac1. Thus, the CMPs may have promoted endothelial damage, an effect that was mitigated by fence enhancement. We suggest, the actin fence is a major protective factor against bacteria‐induced endothelial damage. Actin fence enhancement might be viable therapy against ALI due to septicemia.

Psychosocial Effects of COVID-19 Measures on (Pre-)Dementia Patients During Second Lockdown.

The COVID-19 pandemic poses enormous social challenges, especially during lockdown. People with cognitive decline and their caregivers are particularly at risk of lockdown consequences. To investigate psychosocial effects in (pre-)dementia patients and caregivers during second lockdown and compare effects between first and second lockdown. We included n = 511 (pre-)dementia patients and n = 826 caregivers from the Amsterdam Dementia Cohort and via Alzheimer Nederland. All respondents completed a self-designed survey on psychosocial effects of COVID-19. We examined relations between experienced support and psychosocial and behavioral symptoms using logistic regression. In a subset of patients and caregivers we compared responses between first and second lockdown using generalized estimating equation (GEE). The majority of patients (≥58%) and caregivers (≥60%) reported that family and friends, hobbies, and music helped them cope. Support from family and friends was strongly related to less negative feelings in patients (loneliness: OR = 0.3[0.1-0.6]) and caregivers (loneliness: OR = 0.2[0.1-0.3]; depression: OR = 0.4[0.2-0.5]; anxiety: OR = 0.4[0.3-0.6]; uncertainty: OR = 0.3[0.2-0.5]; fatigue: OR = 0.3[0.2-0.4]; stress: OR = 0.3[0.2-0.5]). In second lockdown, less psychosocial and behavioral symptoms were reported compared to first lockdown (patients; e.g., anxiety: 22% versus 13%, p = 0.007; apathy: 27% versus 8%, p < 0.001, caregivers; e.g., anxiety: 23% versus 16%, p = 0.033; patient's behavioral problems: 50% versus 35%, p < 0.001). Patients experienced more support (e.g., family and friends: 52% versus 93%, p < 0.001; neighbors: 28% versus 66%, p < 0.001). During second lockdown, patients and caregivers adapted to challenges posed by lockdown, as psychosocial and behavioral effects decreased, while patients experienced more social support compared to first lockdown. Support from family and friends is a major protective factor for negative outcomes in patients and caregivers.

Adherence to Mediterranean Diet and Cognitive Abilities in the Greek Cohort of Epirus Health Study.

The Mediterranean diet is commonly proposed as a major modifiable protective factor that may delay cognitive impairment in the elderly. The aim of the study was to investigate the cross-sectional association of adherence to the Mediterranean diet with cognitive abilities in a younger Greek population. A total of 1201 healthy adults aged 21–77 years (mean: 47.8) from the Epirus Health Study cohort were included in the analysis. Adherence to the Mediterranean diet was measured using the 14-point Mediterranean Diet Adherence Screener (MEDAS) and cognition was measured using the Trail Making Test, the Verbal Fluency test and the Logical Memory test. Statistical analysis was performed using multiple linear regression models adjusted for age, sex, education, body mass index, smoking status, alcohol consumption and physical activity. Overall, no association was found between the MEDAS score and cognitive tests, which could be explained by the young mean age and high level of education of the participants. Future studies should target young and middle-aged individuals to gain further understanding of the association between Mediterranean diet and cognition in this age group.